Digital Health Strengthened by New Irish Initiative

St Michael’s Hospital achieved a significant milestone in East Ireland’s journey towards digitally enabled healthcare by going live with an electronic patient management system in its Emergency Department (ED).

The new system will effectively make the ED paper-lite as the core clinical and administrative processes move from being paper-based to electronic.

And representatives from St Michael’s state that this was achieved with no disruption to patient care.

The new software, referred to as MAXIMS, introduces new work-flow processes that are intended to simplify and speed up core activities.

It is hoped that the paperless environment will contribute to better informed clinical decisions and enhanced outcomes for patients.

Following the successful activation of this system, the ED teams gain access to real-time oversight of a patient’s journey through the department.

Live tracking of a patient’s condition using alerts and warnings including life-threatening risk factors, means patients can be prioritised on their level of urgency, triage priority and length of stay.

It is also hoped that patient safety in the department will be greatly improved by using a single healthcare record for each patient, with the intention of seamlessly integrating this into the hospital’s other clinical systems.

Olive Vines, Emergency Department Nurse Manager, St Michael’s Hospital, is enthusiastic about the new system.

“Since the successful go-live, nursing and medical documentation have improved significantly, becoming clearer and more concise. Our workflow processes have become more efficient with the reduction of transcribing patient details into hand written referral and GP letters. Our need for storage of paper notes has also reduced and the introduction of an electronic version of the Manchester Triage system allows the ED to provide standardised patient priority allocation.”

Vines also suggested that the new system has aided collaborative working process at the hospital.

“Switching from a completely outdated, inadequate ED patient assessment and care documentation paper system to MAXIMS has been a dramatic change management project for the staff of St Michael’s ED. The transformation, however, has been a success because of the true partnership approach between us and IMS MAXIMS – from the outset and throughout we worked as one team.”

The next phase of the project will be to make the department completely paperless with the introduction of electronic order communication, assessments for specialist services such as the wound clinic, and e-prescribing.

It is hoped that this new system can be successfully migrated to other institutions and regions in Ireland in the coming months and years.

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New Digital Services Launched for Mental Health Patients

Seven areas across England are set to pilot digital services for mental health patients, which will include innovative apps to improve care and online access to real-time patient records.

NHS England has announced new funding for seven mental health trusts to enable these organisations to pioneer world-class, digital services to improve care for patients experiencing mental health issues.

This will include, for the first time, all key professionals involved in a patient’s care having access to real-time records – from triage and initial assessment, through to admissions or referrals, as well as transfer between services and follow up care.

The trusts will also develop remote, mobile and assistive technologies to empower patients to manage their conditions and enable family and carers to provide the best possible support.

The trusts will have up to £70 million to invest in digital services – consisting £35 million with additional match funding from themselves of £35 million – in order to become ‘Global Digital Exemplars for Mental Health’.

This is intended to ensure that the organisations become world-leading in the use of IT, providing knowledge and expertise to the wider NHS in order to reduce time and costs for others.

This is all part of the NHS’ plan to harness technology to improve services and become more efficient.

With this in mind, Mersey Care NHS Foundation Trust is developing an app, with Stanford University, to anticipate and respond to serious self-harm and suicide risks.

A prototype has been developed and researchers are preparing a feasibility study to explore the usability of the technology and how the digital platform performs against treatment as usual.

Meanwhile, Worcestershire Health and Care NHS Trust has moved from multiple patient record systems to one system across the organisation.

Mobile access to the patient record system will be rolled out to enable staff in the community to access and update a patient’s records.

They will also be improving their overall digital infrastructure, including improving wifi access across its estate, and will be developing mobile apps to improve services for patients and carers.

And Northumberland, Tyne and Wear NHS Foundation Trust is looking to deliver digital patient services including online consultations and enabling patients to access their records, complete assessments and provide feedback on-line.

The Trust’s digital offering will complement traditional face to face services.

Finally, Oxford Health NHS Foundation Trust will be working in partnership with the University of Oxford to develop an online platform for people experiencing a range of conditions (including post-traumatic stress disorder, depression and anxiety) to receive tried-and-tested psychological therapies on their computer or mobile phone.

Professor Keith McNeil, NHS Chief Clinical Information Officer, believes that the initiative will have a massively positive impact on the NHS.

 “As clinicians, we must embrace technology to help us deliver the best care to our service users, just as it helps us in so many other areas of our lives. Digital technology has the potential to transform people’s experience of mental health services and challenge the unacceptable boundaries between physical and mental health. I am excited by this investment across a wide range of services and technologies and the opportunity it presents to provide both improved experience and outcomes for service users across the country.”

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Data Release Statistics Indicate Privacy Problems

Data despatched to NHS, research and private organisations was made vulnerable by inadequate NHS Digital procedures.

Around two-thirds of the data releases from the company between April and August this year included inappropriate information about patients.

1.2 million individuals who have asked for their records not to be shared, other than in circumstances related to direct care, were affected by this issue.

The data was despatched to NHS, research and private organisations.

A public debate is now brewing on whether or not opt outs should apply to these releases.

NHS Digital has argued that it has acted illegally at all times, regardless of respecting the actual wishes of patients.

The organisation believes that it has actually behaved in the best interests of patients, and a spokeswoman for the organisation has argued that there is minimal risk of confidentiality issues from the released data.

Furthermore, NHS Digital has stated that it has ensured that the data has been made anonymous, in accordance with the Information Commissioner’s Office’s code of practice

But the privacy rights campaign group, MedConfidential, suggested that the reports indicated that privacy is not being taken seriously enough, and that “opt outs are not being respected. This goes directly against what patients think is happening when they opt out of their data being shared for reasons beyond direct care”.

The group argues that standards of anonymisation have not been met by NHS Digital.

Commenting further on the issue, coordinator Phil Booth reassured those concerned about the reports that full datasets would eventually be made available to researchers.

“There are perfectly good reasons why some researchers may sometimes require an entire data set, including those who have opted out. Researchers who have a legitimate reason to obtain the full data set can do this by getting permission from the confidential advisory group.”

Releases to private firms have been considered particularly worrying, with around 200 of the releases made without opt-outs being actioned having involved private firms such as Capita.

Booth concluded that the issue will be considered extremely serious by health service observers.

“After the debacle, this will only make people further question whether or not the NHS can be trusted with patients’ confidential and sensitive data.”

Responding to the report, an NHS Digital spokeswoman stated that nothing underhand nor concerning had occurred.

“Our public register details all data releases shared under agreement with organisations, the vast majority of whom are NHS, university or charity bodies. The register includes a very significant number of releases that are anonymised in line with the ICO code of practice, which means the type two opt out is not required given the data is not confidential patient information.”

The spokeswoman further underlined future initiatives related to this issue.

“We are absolutely committed to upholding patient opt-outs and continue to do so in line with legislation and working closely with bodies like the ICO and the [national data guardian]. We are also committed to making details of what we do public, which is why we added the application of opt outs to the register.”

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Simon Stevens Wrestling with NHS Digital Future

Health leaders have been encouraged to invest in the digital future of the NHS, as the health service continues to struggle with a mismatch between resources and demand.

And with this in mind, Simon Stevens, chief executive of the NHS in England, has imagined and begun to outline a future in which digital interaction between patients and the NHS is a common occurrence.

Stevens states that those currently in their teens, 20s and 30s will eventually book appointments digitally on a regular basis.

“The idea of booking appointments and physically turning up to GP surgeries for routine things [will become] an alien concept,” Stevens asserted.

There is certainly already a push within the health service to embrace technology, yet the gargantuan nature of the NHS sometimes means that such innovation is difficult to achieve.

One of the particularly difficult logistical problems for the NHS is that there is something of a productivity paradox inherent in digitalisation.

While introducing a new technology can ultimately result in a rise in output, they can be a delay between this being realised during which the investment appears to be a waste of money.

One of the foremost articulators of this paradox has been professor Robert Wachter; interim chairman of the department of medicine at the University of California, San Francisco.

Wachter recently told a summit organised by the Nuffield Trust that employees tended to have a vested interest in continuing the old ways of working.

“[Staff are] just not very good at envisioning fundamental changes in the way they work”, Wachter asserted, before citing a quotation often attributed to Henry Ford. “If I’d asked people what they wanted, they would have said ‘faster horses’.”

Considering his prominent position in healthcare technology, Wachter has been recruited by the NHS to lead a review of computer systems across the health service for NHS England.

This is intended to enable the professor to both advise and tap into the expertise of existing employees.

With the NHS looking to greatly shift its operations in the coming years, pioneering individuals within the health service are particularly important.

One such pioneer is Bridget Fletcher, chief executive of Airedale Hospital in West Yorkshire, who has placed her institution at the forefront of so-called “telemedicine”.

While Yeovil District Hospital has worked out which patients were imposing the biggest strains on the local health system via computing.

They concluded that just 4 per cent of local people were consuming up to 50 per cent of the health and social care budget.

Hospital boss Paul Mears commented that despite the efforts of Yeovil, other institutions in the health service have been hesitant to implement technology successfully.

“You look at other industries nowadays, how they use technology to integrate and interface with their customers: we’re still quite a long way behind that in the NHS in terms of the way we operate and the way we interact with patients.”

As the NHS is challenged in the coming years, there will be increasing pressure on health service bosses to implement a digital revolution to make the NHS work better.

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Smart Glasses to Assist Surgeons with Critical Surgery

Technology experts in Scotland are developing so-called smart glasses which could be utilised in order to assist doctors in the performing of surgery.

The technology is redolent of Google Glass; a consumer electronics products that was shelved after Google failed to achieve sufficient market penetration.

However, it is hoped that a similar development could be used in the health service in Scotland, and consultations are already underway to successfully implement this technology.

NHS Highland has revealed it is working with hi-tech companies to create the glasses – and believe it could attract worldwide interest and “significant” revenues for the health board.

If completed it would mean that Scotland would be the first country in Europe to develop and ultimately implement the smart glasses technology for medical usage.

Smart glasses are effectively a wearable computer, connecting to the Internet and providing feedback to the surgeon in real-time.

They also contain a variety of self-contained mobile applications, while having the functionality to project images onto the lens of the glasses while allowing the user to see as normal.

Other features which are common in mobile technology are also included, such as a high-resolution camera and voice recognition software which has the ability to turn speech into text.

NHS Highland has set up a board of medics to consider the potential uses for the glasses, and is keen to hear from interested colleagues, academics and businesses.

There may be concern that this could prove to be something of an expensive red herring, particularly after the failure of Google Glass to capture the imagination of consumers.

Similarly, the Apple Watch smartwatch which was released by Apple last year, has not perhaps being as enthusiastically received as the consumer electronics giant would have hoped.

The experience of these two technology releases suggests that niche devices often fail to deliver the vision of the manufacturer.

Nonetheless, Alan Whiteside, innovation consultant with NHS Highland’s research, development and innovation department, believes that the glasses will be valuable to both surgeons and those working in casualty departments.

Whiteside took time to outline where he believed the smart glasses could be implemented.

“It’s early days yet but several clinicians have already indicated that they are very interested in the glasses and have suggested some possible applications. The plan is to turn these ideas into reality and take it from there. If things go as we hope, the smart glasses could help to put NHS Highland at the forefront internationally of a technology with vast potential.”

NHS Highland is working on the development of the glasses with Summit Wearable Solutions, an Inverness-based company.

“If this is commercially successful we would have intellectual property rights and it’s possible that this project could ultimately yield a significant income for us. This is the first place in Europe seriously developing digital eyewear for healthcare. I have no doubt that it could put help to NHS Highland on the map as a centre of technological innovation,” Whiteside added.

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Sheffield NHS Trust Besieged by Data and IT Problems

An electronic patient record system has been blamed for a massive financial shortfall at Sheffield Teaching Hospitals NHS Foundation Trust.

The so-called Lorenzo system has been fingered as a major problem by an integrated performance report carried out by the board of directors at the trust.

Sheffield Teaching Hospitals NHS Foundation Trust went live with Lorenzo in September last year but, according to the report, it is one of the main reasons that Sheffield Teaching Hospitals has underperformed.

“The under-performance remains largely in respect of elective activity, out-patients, critical care and a larger than expected deduction for emergency re-admissions within 30 days. There are still data issues following the implementation of the new Lorenzo PAS [patient administration system] towards the end of September, which are creating challenges in reporting complete and accurate income figures,” the report claims.

Additionally, the report states that the operational impact of the new system has been largely negative for the Sheffield-based trust, with the booking and scheduling processes, particularly in out-patient services, being particularly detrimentally influenced.

Since the implementation of Lorenzo, the trust has seen a rise in did not attend (DNA) rates for outpatient appointments, with an analysis of the issues has shown that for some patients the DNA status was recorded incorrectly.

And the new system has also caused problems with a variety of administrative processes, which have concurrently affected pathway management.

This is obviously extremely concerning, as the Lorenzo system was essentially intended to improve administration at the Sheffield trust, whereas in reality the opposite appears to have occurred.

With the trust having seemingly openly acknowledged that the system is causing difficulties, Lorenzo system experts have been summoned to visit outpatient areas with the intention of recommending changes to existing processes.

The problems experienced by the Sheffield trust are a long way from being the first associated with a public IT system.

Major national projects have indeed been shelved owing to IT difficulties, with the government recently announcing that it is to review £500 million of Atos contracts owing to IT failings.

The report on The Lorenzo system based in Sheffield stated that the trust has been financially impacted by the implementation of the system, and that this remains of considerable concern.

It added that action was being pursued to improve the delivery of activity, efficiency and financial plans and to mitigate risks and to maximise contingencies.

“Resolving the issues following the Lorenzo implementation and getting activity back to normal levels is critical,” it said.

The Sheffield Teaching Hospitals NHS Foundation Trust is just one NHS trust facing financial problems, as trusts all over the NHS run up sizeable deficits.

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New App to Help Predict and Prevent Suicide

An NHS mental health trust is collaborating with researchers in the United States in order to develop an app that may have a positive influence on suicide.

Liverpool-based Merseycare and Stanford University have been in talks on how the technology could work.

The aim of the two organisations is to produce a prototype by June of this year, with the aim to have the first patients monitored by the final application by January 2017.

Suicide remains a major killer in Britain, however there were 6,122 suicides in the UK in 2014; a 2% decrease on the year before.

The aim of the app is to enable clinicians and medics working in the NHS to provide 24-hour observations on people at risk of killing themselves.

In order to achieve this, the app will monitor all digital communications carried out by a patient, including emails, social media and phone calls.

This has led to criticism in some quarters that the app can be seen as a form of snooping, but it is worth noting that all patients must volunteer for the service.

Commenting on the development of the software, Dr David Fearnley, medical director at Merseycare, indicated that its potential is massive.

“We think we can anticipate people who may be likely to harm themselves with greater accuracy than we currently do, and therefore be able to do something about it and save their lives. This is an opportunity to exploit technology in a way we’ve never been able to before in health, by providing very powerful, decision-making, statistical support to clinicians in real time for the people who are most at risk.”

Merseycare has already made some very bold commitments with regard to suicide targets.

Just last year, the organisation indicated that it intends to instigate a zero suicide policy by the end of the decade, meaning that all suicides of service users will be prevented.

While the app is considered to be an important part of the process, numerous other initiatives will combine with the software in order to improve the way that suicide is handled.

The initiative requires a new approach across the trust, from staff training to greater patient involvement.

Five NHS trusts and hospitals in the United States have collaborated in the development of the app, creating new technology that will have a major influence over the prevention suicide in the future.

Indeed, the technology involved in the new application is already scanning data being inputted into the trusts in question, while also digitising and analysing it.

It is therefore already possible for the app to inform medics where danger signs are emerging for potentially suicidal patients.

Merseycare and Stanford are aiming for patients to start using the app in January 2017; its success will then be evaluated by outside experts over the following three years.

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IT Survey Indicates that Security Arrangements in the NHS are Insufficient

A survey of digital security in the NHS conducted by a major Internet firm reveals some interesting results and perceptions related to the health service.

Sophos interviewed 250 NHS-employed CIOs, CTOs and IT Managers and found that there is a significant gulf between the way that digital security is perceived in the NHS, and how it actually operates in reality.

Of those surveyed, 76 per cent think they’re suitably protected against cyber-attacks.

On the other hand, 72 per cent say data loss is their biggest concern when it comes to IT security.

IT managers were also of the opinion that encrypting NHS data is particularly critical, yet this can be considered another major area of concern.

In fact, the encryption of data in the NHS is rather paltry, with only 10% of respondents indicating that encryption is well established within that particular NHS organisation.

59 per cent of employees have some sort of email encryption, while file sharing encryption is used by 49 per cent of employees, and 34 per cent have encrypted their data stored in the cloud.

These must be considered extremely inadequate figures considering the sensitivity of the data involved, and the hostile environment that is the contemporary internet.

It seems that the perennial issue of finance plays a major part in the way that IT security is dealt with in the NHS.

There is a constant balance to be found between protecting information and saving money, and the Sophos survey found that this is a critical element of the overall digital culture of the NHS.

The Sophos survey also interestingly states that 42 per cent have cited mobile use as the main initiative driving change in the industry.

Commenting on the findings from the survey, Jonathan Lee, UK Healthcare Sector Manager for Sophos UK and Ireland, struck a note of caution, suggesting that the NHS should play very close attention to the trends outlined in the research.

“This study highlights that NHS organisations still face significant IT security issues and that IT decision makers have work to do to address gaps in their security. Failure to take the necessary precautions to keep cyber criminals out, to safeguard data and ultimately to protect patients and staff will continue to cause significant problems for NHS organisations. However, budget cuts and changes to working practices, such as the increase in mobile working, all present significant challenges within the sector.”

In particular, Lee felt that the NHS should beef up its encyrption arrangements considerably, recognising it as an area in which the health service has been neglectful.

“It’s no surprise that only 10 per cent of NHS organisations stated that encryption was well established within their organisation. Most have encrypted laptops and USB sticks because they have been mandated to do so, but, currently, that is often where it stops.”

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Department of Health Report Opines NHS Technology Investment Required

According to a spending review carried out by the Department of Health, the NHS will need an increase of £5.6 billion in funding in order to deliver its technology plans.

Negotiations in the health sector are still unfolding ahead of the government’s 25th November spending review announcement.

This document is expected to set all government spending plans until the end of the decade, with current proposals for spending on IT in the NHS considered unknown.

Details of the funding issue in the NHS have been outlined by a paper produced by DH director of informatics delivery management Tim Donohoe.

This paper was discussed at the National Information Board’s October board meeting.

It is stated by the document that spending on technology in the NHS needs to increase between an estimated range of £3.3 billion to £5.6 billion.

The Treasury is challenged to invest more work on refining the costs for the sector, with investment in data and digital management considered to be particularly important in the overall spend.

It is important to emphasise that this is not a finalised document, with the paper declaring itself to be draft analysis subject to internal review and validation by NHS stakeholders.

And with numerous stakeholders potentially affected by this issue, there could yet be changes to the preliminary plans.

Nonetheless, the Department of Health has spent the last three months identifying appropriate technology programs and digging into their estimated costs and benefits.

This initiative has been conducted in collaboration with consultants Deloitte and McKinsey.

It was reported back in June that work carried out for NHS England by McKinsey had calculated that IT expenditure in the NHS could ultimately result in efficiency savings of £10 billion by the end of the decade.

NHS England has indicated that the report from which this figure is derived will be published by the end of this month.

The £10 billion figure will be particularly encouraging for the Conservative government and the hierarchy of the NHS, as the Tories have already challenged the health service to find efficiency savings in the region of £25 billion by 2020.

This new report on NHS IT expenditure sets out nine ‘domains” in which it needs to find funding, with a breakdown of requirements in these areas.

The biggest of these domains is paper-free health care and related transactions, with the research suggesting that projects in this field will require over £3 billion of investment.

With the government already committed to increasing NHS spending by £8 billion, it will be interesting to see how the spending review responds to this research.

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Report Suggests Teenage Tech Time Should be Rationed

A major think tank has strongly criticised the influence of technology companies over the health of young people in particular.

The Strategic Society Centre (SSC) has gone as far as comparing the influence of technology firms to tobacco companies.

Concerned about the impact of technology products on the mental health of young people, the SSE has called on technology manufacturing companies to take responsibility for the threats that their products pose to young people.

In particular, the SSC has mooted the idea of establishing guidelines for the recommended daily use of any technology product by young people.

The claims have been published in ‘Screened Out’; a report which particularly focuses on smartphone manufacturers and online social networking sites.

Contrary to the generally perceived public opinion of these aspects of our collective culture, the SSE suggests that both of these commonly utilised forms of technology can have a significantly negative influence on young people in particular.

The SSE calls on companies involved in these technological niches to consider how young people can be detrimentally affected by their businesses.

This possibly controversial, and certainly contentious, report was produced in response to research by Dr Cara Booker of the Institute for Social and Economic Research at the University of Essex, published in the American Journal of Public Health.

It found that 10 to 15-year-olds who chatted regularly on social networking websites and video game consoles were associated with greater possibility of socio-emotional difficulties.

Additionally, Booker concluded that particularly heavy use of popular technology such as smartphones, tablets and video game consoles can correlate with lower levels of happiness and fulfilment among adolescents.

In line with this report, the SSE has produced a series of guidelines that it believes would have a strongly beneficial impact on the well-being of adolescents.

It is hoped that the drawing up of these guidelines and the recommendations of the report in general will help encourage technology companies to acknowledge their responsibilities in this area.

While studies can often be contradictory with regard to technology, it has been notable in the past that companies such as video games producers have strongly opposed any suggestions that their games could be harmful.

Nonetheless, the SSC wants national guidelines to be issued on the recommended amount of screen time young people should engage with technology each day, while hardware and online experiences should also be redesigned to ensure adolescents’ general well-being.

Booker claims that the proliferation of social media and access to the internet through computers and handheld devices is “one of the greatest changes to society” in recent decades.

“One of the consequences of this increase in use is the effect it has on those who use it, particularly adolescents. The evidence regarding use of social media and wellbeing is growing and it is imperative that researchers, government and private industries work together to address the real public health consequences of poor wellbeing in adolescence becoming worse wellbeing in adulthood. This issue is not one that parents alone can tackle; it is one that requires government and private industry to raise awareness of the potential issues with prolonged use of social media for children and adolescents,” Booker stated.

In October, 2014, it was reported that by digital analysts at GSMA Intelligence that there are now more Internet devices in circulation than people.

This is only expected to exacerbate in the coming years as the Internet of Things becomes a viable mainstream technology.

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NHS Continues Shift to Paperless Environment

As the NHS continues on its journey towards becoming a paperless organisation by 2018, a new initiative is helping keep medical records secure and free from paper.

Pearl Scan Solutions is playing a significant role in assisting GP surgeries, health trusts and hospital departments with the implementation of electronic storage systems.

This is a particularly important programme for the NHS, as it is estimated by the government that the cost of physical paper storage is somewhere in the region of £500,000 and £1 million per year for each healthcare trust.

As part of its arrangement with Pearl Scan Solutions, every patient in the NHS will be provided with a barcode in order to streamline operations in the healthcare service.

It is also suggested that NHS apps could be developed in the near future, which will enable people to book appointments and order prescriptions via their smartphones or other mobile devices.

Research has suggested that a fluent and intuitive digital system could help save the NHS millions of pounds every year.

Such an initiative would enable medication errors to be reduced, allow storage space to be generated, and ultimately save on both time and resources.

It is also thought that an NHS-wide revolution into digital storage systems could help cut down on administration errors and further improve data protection.

One recent such example of this came from a hospital in Essex. Goodmayes Hospital in Illford accidentally sent a patient’s entire personal medical record to another person via the post.

The patient in question was perturbed by the accidental leaking of sensitive information.

Speaking about the initiative with the NHS, Naveen Ashraf, managing director of Pearl Scan Solutions, pointing out that medical records can easily go awry in what is a pressurised environment.

“Medical records are strictly private and confidential, so this story highlights what can go wrong in busy NHS environments with an overworked workforce,” Ashraf stated.

Ashraf also took time to outline the benefits of a paperless office environment.

“Medical staff make mistakes too, they are only human – but by having a paperless NHS, we can further safeguard patients and ensure all medical records are safe and secure. They are also much more easily accessible, which will speed up treatment and generally improve care across the board,” Ashraf asserted.

As the NHS continues the transformation into the digital age, it is expected that hospitals, surgeries, dentists and other medical organisations will become much more efficient.

With pressure on NHS budgets, it was suggested by the existing Health Secretary, Jeremy Hunt, that paperless working within the NHS could save £4.4 billion.

Regardless of the validity of these claims, it is broadly accepted that paperless working is more efficient, and the NHS is indeed committed to instigating this form of operation.

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